Reduced-pressure, abdominal treatment systems and methods

ABSTRACT

A method of manufacturing a reduced-pressure abdominal treatment system for treating an open abdominal cavity is provided. In some embodiments, the reduced-pressure abdominal treatment system has an open-cavity treatment device for providing reduced-pressure treatment to an abdominal cavity; a deep-tissue closure device for applying a closing force on a deep-tissue wound; and a surface-wound closure subsystem for providing a closing force on a surface wound. The method of manufacturing may also include providing a reduced-pressure supply subsystem. A method of treatment using a reduced-pressure abdominal treatment system is also disclosed.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.14/078,140, entitled “Reduced-Pressure, Abdominal Treatment Systems andMethods,” filed Nov. 12, 2013, which is a divisional of U.S. applicationSer. No. 12/467,211, entitled “Reduced-Pressure, Abdominal TreatmentSystems and Methods,” filed May 15, 2009, which claims the benefit ofthe filing of U.S. Provisional Patent Application Ser. No. 61/109,486,entitled “Reduced-Pressure, Abdominal Treatment System and Method,”filed Oct. 29, 2008; U.S. Provisional Patent Application Ser. No.61/109,390, entitled “Open-Cavity, Reduced-Pressure Wound Dressing andSystem,” filed Oct. 29, 2008; U.S. Provisional Patent Application Ser.No. 61/109,410, entitled “Reduced-Pressure, Wound-Closure System andMethod,” filed Oct. 29, 2008; and U.S. Provisional Patent ApplicationSer. No. 61/109,448, entitled “Reduced-Pressure, Deep-Tissue ClosureSystem and Method,” filed Oct. 29, 2008. Priority is claimed to all ofthe above-mentioned applications, and each application is herebyincorporated by reference.

BACKGROUND

The present invention relates generally to medical treatment systemsand, more particularly, to reduced-pressure, abdominal treatment systemsand methods.

Whether the etiology of a wound, or damaged area of tissue, is trauma,surgery, or another cause, proper care of the wound is important to theoutcome. Unique challenges exist when the wound involves locations thatrequire reentry, for example, the peritoneal cavity and more generallythe abdominal cavity. Often times when surgery or trauma involves theabdominal cavity, establishing a wound management system thatfacilitates reentry allows for better and easier care and helps toaddress such things as peritonitis, abdominal compartment syndrome(ACS), and infections that might inhibit final healing of the wound andthe internal organs. In providing such care, it may be desirable toremove unwanted fluids from the cavity, help approximate the fascia andother tissues, and finally to help provide a closing force on the wounditself at the level of the epidermis.

Currently, an abdominal opening on the epidermis may be closed usingsutures, staples, clips, and other mechanical devices to allow the skin,or epidermis, to be held and pulled. Such devices often cause puncturewounds or other wounds. If severe edema occurs, tremendous pressure maybe placed on the closure device with potential harm resulting. Forexample, if the pressure rises due to edema, the sutures may tear out.

With respect to the overall system for allowing reentry into theabdominal cavity, a number of techniques have been developed. Oneapproach is to place towels down into the abdominal cavity and then useclips, such as hemostats, to close the skin over the towels. Whilesimple and fast, the results have been regarded as suboptimal. Anotherapproach is the “Bogota bag.” With this approach, a bag is sutured intoplace to cover the open abdomen in order to provide a barrier. Stillanother approach, sometimes called a “vac pack,” has been to pack towelsin the wound and then place a drain into the abdomen and cover theabdomen with a drape. Finally, a reduced pressure approach has beenused. Such an approach is shown in U.S. Pat. No. 7,381,859 to Hunt etal. and assigned to KCI Licensing, Inc. of San Antonio, Tex. U.S. Pat.No. 7,381,859 is incorporated herein by reference for all purposes.

A number of deep tissues, e.g., fat, muscle, or particularly fascia, maybe addressed when one is temporarily closing the abdomen. Unlessotherwise indicated, as used herein, “or” does not require mutualexclusivity. If not addressed, the deep tissue may retract further intothe abdominal cavity and subsequently cause difficulties. The surgeonmay suture the deep tissue, e.g., the fascia, while placing the fasciaunder tension. This can be problematic, however, if reduced-pressuretreatment in the area is desired or if the dressing needs to bereplaced. Moreover, suturing the deep tissue can at times causenecrosis. At the same time, if the deep tissue, notably the fascia, isnot closed, this situation can lead to hernias and other complications.

In addition to accessing the abdominal cavity for reentry, it isdesirable to remove fluids. It may also be desirable to providereduced-pressure therapy to the tissue site, including wounds that maybe within the abdominal cavity. Clinical studies and practice have shownthat providing a reduced pressure in proximity to a tissue site augmentsand accelerates the growth of new tissue at the tissue site. Theapplications of this phenomenon are numerous, but application of reducedpressure has been particularly successful in treating wounds. Thistreatment (frequently referred to in the medical community as “negativepressure wound therapy,” “topical negative pressure,” “reduced pressuretherapy,” or “vacuum therapy”) provides a number of benefits, includingfaster healing and may increase formulation of granulation tissue.

SUMMARY

Problems with existing abdominal treatment systems and methods areaddressed by the systems, apparatus, and methods of the illustrativeembodiments described herein. According to one illustrative embodiment,a reduced-pressure abdominal treatment system includes an open-cavitytreatment device for providing reduced-pressure treatment proximate apatient's abdominal contents, a deep-tissue closure device for applyinga closing force on a deep-tissue, e.g., a patient's fascia, and areduced-pressure treatment subsystem for providing reduced-pressuretreatment in the patient's abdominal cavity. The reduced-pressuretreatment system may also include a surface-wound closure subsystem forproviding a closing force on the patient's epidermis. Thereduced-pressure treatment system may also include a reduced-pressuresupply subsystem operable to develop reduced pressure for use in theopen-cavity treatment device, deep-tissue closure device, thereduced-pressure treatment subsystem, and the surface-wound closuresubsystem.

According to illustrative embodiments, a method of treating an openabdominal cavity includes disposing in the abdominal cavity anopen-cavity treatment device, which has a first side and a second,inward-facing side. The second, inward-facing side of the open-cavitytreatment device can be disposed proximate a patient's abdominalcontents. The method of treating an open abdominal cavity may furtherinclude the step of disposing in the open abdominal cavity a deep-tissueclosure device, which has a first side and a second, inward-facing side.The deep-tissue closure device can be disposed with the second,inward-facing side of the deep-tissue closure device proximate the firstside of the open-cavity treatment device and the first side of thedeep-tissue closure device proximate the fascia. The method of treatingan open abdominal cavity may further include disposing a manifold withinthe patient's abdominal cavity, forming a pneumatic seal over thepatient's abdominal cavity, and fluidly coupling a firstreduced-pressure interface to the manifold. The method may furtherinclude releasably attaching a first attachment member to a firstportion of the patient's epidermis proximate an edge of the surfacewound and releasably attaching a second attachment member to a secondportion of the patient's epidermis proximate the edge of the surfacewound. The first attachment member may be spaced from the secondattachment member. The method of treating an open abdominal cavity mayfurther include providing a sealed contracting member coupled to thefirst attachment member and the second attachment member and operable tocontract when placed under reduced pressure. As part of the method,reduced pressure may be supplied to the open-cavity treatment device,the deep-tissue closure device, the manifold, and the sealed contractingmember.

According to other illustrative embodiments, a method of manufacturing asystem for treating an open abdominal cavity of a patient may includeforming an open-cavity treatment device for providing reduced-pressuretreatment to a patient's abdominal cavity; forming a deep-tissue closuredevice for applying a closing force on a deep-tissue wound on apatient's fascia; and forming a surface-wound closure subsystem forproviding a closing force on a surface wound on the patient's epidermis.The method of manufacturing may also include the step of providing areduced-pressure supply subsystem.

According to other illustrative embodiments, a method of manufacturing asystem for treating an open abdominal cavity may include forming acentral connection member and a non-adherent drape, coupling a pluralityof encapsulated leg members to the central connection member and to thenon-adherent drape, disposing a leg manifold member within interiorportions of each of the encapsulated leg members, and formingfenestrations in the encapsulated leg members. Additionally, acontractible matrix may be formed to be applied proximate thenon-adherent drape. The method of manufacturing may also include forminga plurality of attachment members for releasably attaching to apatient's epidermis and forming a sealed contracting member operable tocontract when placed under reduced pressure.

Other illustrative embodiments may include a method of manufacturing anabdominal treatment system, the method comprising forming an open-cavitytreatment device, forming a deep-tissue closure device, providing aplurality of attachment-base members, providing a plurality ofconnecting members, wherein the plurality of attachment-base members andthe plurality of connecting members may couple to provide an interiorspace, and disposing a sealed contracting member within the interiorspace. A reduced-pressure treatment subsystem may also be provided.

Other objects, features, and advantages of the illustrative embodimentswill become apparent with reference to the drawings and detaileddescription that follow.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic, cross sectional view, with a portion in blockdiagram, of an illustrative reduced-pressure, abdominal treatmentsystem;

FIG. 2 is a schematic cross section of a portion of the illustrativereduced-pressure, abdominal treatment system of FIG. 1 showing a portionof an encapsulated leg member;

FIG. 3 is a schematic cross section of a portion of the illustrativereduced-pressure, abdominal treatment system of FIG. 1 showing a portionof an encapsulated leg member;

FIG. 4 is a schematic cross section of a portion of the illustrativereduced-pressure, abdominal treatment system of FIG. 1 showing a centralconnection member;

FIG. 5 is a schematic, perspective view of the open-cavity,reduced-pressure treatment device of FIG. 1;

FIG. 6 is a schematic, plan view of an open-cavity, reduced-pressuretreatment device according to another illustrative embodiment;

FIG. 7 is a schematic, plan view of a detail of the treatment device ofFIG. 6;

FIG. 8 is a schematic cross section of a portion of the treatment deviceof FIG. 7 taken along line 8-8;

FIG. 9 is schematic, perspective view of another illustrative embodimentof an open-cavity, reduced-pressure treatment device;

FIG. 10 is a schematic, cross-sectional view of a detail of theillustrative deep-tissue closure subsystem of FIG. 1;

FIG. 11 is a schematic, perspective view, which shows a first side(top), of a contractible matrix according to one illustrativeembodiment;

FIG. 12 is a schematic, perspective view, which shows a second(inward-facing) side, of the contractible matrix of FIG. 11;

FIG. 13 is a schematic, top view of another illustrative embodiment of acontractible matrix;

FIG. 14 is a detail of a portion of the contractible matrix of FIG. 13;

FIG. 15 is a schematic, perspective view of a portion of an illustrativeembodiment of a contractible matrix;

FIG. 16 is a schematic, cross-sectional view of a portion of theillustrative surface-wound closure subsystem of FIG. 1;

FIG. 17A is a schematic, perspective view of an illustrative embodimentof a reduced-pressure, surface-wound closure subsystem;

FIGS. 17B and 17C are schematic, plan views of the reduced-pressure,surface-wound closure system of FIG. 17A shown in a non-contractedposition (FIG. 17B) and a contracted position (FIG. 17C);

FIG. 18 is a schematic, perspective view of an illustrative embodimentof an attachment-base member for use as part of an illustrativeembodiment of a surface-wound closure subsystem;

FIG. 19 is a schematic, perspective view of an illustrative embodimentof a connection member for use as part of an illustrative embodiment ofa surface-wound closure subsystem;

FIG. 20 is a schematic, perspective view of an illustrative embodimentof a reduced-pressure interface member for use as part of anillustrative embodiment of a surface-wound closure subsystem;

FIGS. 21A and 21B are schematic, plan views of an illustrativeembodiment of a reduced-pressure, surface-wound closure subsystem shownin a non-contracted position (FIG. 21A) and a contracted position (FIG.21B);

FIG. 22 is schematic, perspective view of an illustrative embodiment ofa modular, reduced-pressure, surface-wound closure subsystem;

FIG. 23A is a schematic, perspective view of an illustrativereduced-pressure connector;

FIG. 23B is an elevational view of the reduced-pressure connector ofFIG. 23A;

FIG. 24A is a schematic, cross-sectional view of a portion of anotherillustrative embodiment of a reduced-pressure, wound-closure andtreatment system;

FIG. 24B is a schematic, cross-sectional view of a portion of anotherillustrative embodiment of a reduced-pressure, wound-closure andtreatment system;

FIG. 25 is a schematic, perspective view of an illustrative embodimentof a portion of a reduced-pressure, surface-wound closure subsystemshowing, amongst other things, an illustrative embodiment of a pluralityof modular closing members;

FIG. 26 is a schematic, cross-section of a portion of a modular closingmember of FIG. 25;

FIG. 27 is a schematic, perspective view of the illustrativewound-closure subsystem of FIGS. 25-26 shown applied over a surfacewound of a patient;

FIG. 28 is a schematic, cross-sectional view of an illustrativeembodiment of a portion of an illustrative embodiment of a sealedcontracting member; and

FIG. 29 is a schematic, cross-sectional view of an illustrativeembodiment of an attachment member.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

In the following detailed description of the illustrative embodiments,reference is made to the accompanying drawings that form a part hereof.These embodiments are described in sufficient detail to enable thoseskilled in the art to practice the invention, and it is understood thatother embodiments may be utilized and that logical structural,mechanical, electrical, and chemical changes may be made withoutdeparting from the spirit or scope of the invention. To avoid detail notnecessary to enable those skilled in the art to practice the embodimentsdescribed herein, the description may omit certain information known tothose skilled in the art. The following detailed description is,therefore, not to be taken in a limiting sense, and the scope of theillustrative embodiments are defined only by the appended claims.

System Introduction

Referring primarily to FIG. 1, an illustrative embodiment of areduced-pressure, abdominal treatment system 30 is presented. Thereduced-pressure, abdominal treatment system 30 is for use in treating,or managing, a patient's abdominal cavity 32 and tissue or woundsassociated with an open abdomen. As used herein, “wound” signifies adamaged area of tissue. The reduced-pressure, abdominal treatment system30 may be used to treat a general tissue site 34; a deep-tissue wound ina deep tissue, such as in fascia 36, muscle 40, fat layer 42; and asurface wound 180 in epidermis 44. The wound in the fascia 36 has fasciaedges 38. The surface wound 180 in the epidermis 44 has surface-woundedges 182. The tissue site 34 is shown on or proximate abdominalcontents 46. The tissue site 34 may be the bodily tissue of any human,animal, or other organism. In this embodiment, the tissue site 34generally includes tissue in the abdominal cavity 32 and typicallytissue proximate the abdominal contents 46.

The reduced-pressure, abdominal treatment system 30 includes anopen-cavity treatment device 50 that is part of an open-cavity treatmentsubsystem 52. The open-cavity treatment subsystem 52 helps providereduced-pressure treatment in the patient's abdominal cavity 32 andprovides a non-adherent cover for the abdominal contents 46. Thereduced-pressure, abdominal treatment system 30 also includes adeep-tissue closure device 54 that is part of a deep-tissue closuresubsystem 56. The deep-tissue closure subsystem 56 applies a closingforce on a tissue and is particularly well suited for providing aclosing force on a deep tissue, e.g., the fascia 36. The deep-tissueclosure subsystem 56 may help approximate the fascia edges 38. Thereduced-pressure, abdominal treatment system 30 also provides generalreduced-pressure treatment with a reduced-pressure treatment subsystem58. The surface wound 180 on the epidermis 44, and particularly thesurface-wound edges 182, may be urged toward a central portion, ortowards each other, by a closing force developed by a surface-woundclosure subsystem 60. Finally, the reduced-pressure, abdominal treatmentsystem 30 may include a reduced-pressure supply subsystem 62 thatprovides reduced pressure to various devices and subsystems within thereduced-pressure, abdominal treatment system 30. Each of the devices andsubsystems will be described in more detail further below.

The reduced pressure delivered by the reduced-pressure, abdominaltreatment system 30 may be applied in the abdominal cavity 32 and totissue site 34 to help promote removal of exudates, ascites, or otherliquids, bacteria, fibrin, dead tissue, toxins, residual blood, etc. Insome instances reduced pressure may be applied to stimulate the growthof additional tissue, and in some instances, only fluid removal may bedesired. In the case of a wound at the tissue site 104, the growth ofgranulation tissue and removal of exudates and bacteria may help topromote healing of the wound. As used herein, “reduced pressure”generally refers to a pressure less than the ambient pressure at thetissue site 34 that is being subjected to treatment. In most cases, thisreduced pressure will be less than the atmospheric pressure at which thepatient is located. Alternatively, the reduced pressure may be less thana hydrostatic pressure of tissue at the tissue site 34. Unless otherwiseindicated, values of pressure stated herein are gauge pressures.

Reduced-Pressure Treatment Subsystems

An illustrative embodiment of a reduced-pressure subsystem, e.g., thereduced-pressure subsystem 58, will now be presented. Thereduced-pressure treatment subsystem 58 includes a manifold 64, asealing member 66 (or over-drape), and a reduced-pressure interface 72.The manifold 64 is shown disposed within the abdominal cavity 32. Thesealing member 66 is placed over the surface wound 180 on the epidermis44 to form a pneumatic seal over the abdominal cavity 32.

The manifold 64 may take many forms. The term “manifold” as used hereingenerally refers to a substance or structure that is provided to assistin applying reduced pressure to, delivering fluids to, or removingfluids from a tissue site, e.g., tissue site 34. The manifold 64typically includes a plurality of flow channels or pathways thatdistribute fluids provided to and removed from the area of tissue aroundthe manifold 64. The manifold 64 may include a plurality of flowchannels or pathways that are interconnected to improve distribution offluids. The manifold 64 may be a biocompatible material that is capableof being placed in contact with tissue and distributing reducedpressure. Examples of manifold 64 include, without limitation, devicesthat have structural elements arranged to form flow channels, cellularfoam, such as open-cell foam, porous tissue collections, and liquids,gels and foams that include or cure to include flow channels. Themanifold 64 may be porous and may be made from foam, gauze, felted mat,or any other material suited to a particular biological application. Inone embodiment, the manifold 64 is porous foam and includes a pluralityof interconnected cells or pores that act as flow channels. The porousfoam may be a polyurethane, open-cell, reticulated foam, such as aGranuFoam® material provided by Kinetic Concepts, Incorporated of SanAntonio, Tex. Other embodiments might include “closed cells” to directfluid flow in the manifold 64. In some situations, the manifold 64 mayalso be used to distribute fluids, such as medications, antibacterials,growth factors, and other solutions into the abdominal cavity 32 or atthe tissue site 34. Other layers may be included in the manifold 64,such as an absorptive material, wicking material, hydrophobic material,or hydrophilic material.

The sealing member 66 is placed over the abdominal cavity 32 and thesurface wound 180 to provide a pneumatic seal between the sealing member66 and the patient's epidermis 44. The pneumatic seal is adequate forreduced-pressure, abdominal treatment system 30 to hold reduced pressureat the tissue site 34. The sealing member 66 may be used to secure themanifold 64 on a central connection member 96 or on a portion of thedeep-tissue closure subsystem 56 as shown in FIG. 1. While the sealingmember 66 may be impermeable or semi-permeable, the sealing member 66 iscapable of maintaining reduced pressure at the tissue site 34 afterinstallation of the sealing member 66 and other system components. Thesealing member 66 may be a flexible over-drape, cover, or film formedfrom a silicone based compound, acrylic, hydrogel or hydrogel-formingmaterial, or any other biocompatible material that includes theimpermeability or permeability characteristics desired for the tissuesite.

The sealing member 66 may further include an attachment device 68 tosecure the sealing member 66 to the patient's epidermis 44 or to agasket member around the surface-wound edges 182. The attachment device68 may take many forms; for example, an adhesive 70 may be positionedalong a perimeter of the sealing member 66 or any portion of the sealingmember 66 to provide, directly or indirectly, the pneumatic seal withthe patient's epidermis 44. The adhesive 70 might also be pre-appliedand covered with a releasable backing, or member, that is removed at thetime of application.

The reduced-pressure interface 72 permits the passage of fluid from themanifold 64 to a first reduced-pressure delivery conduit 76 and viceversa. The reduced-pressure interface 72 may be, as one example, a portor connector 74. Thus, fluids collected from the abdominal cavity 32using the manifold 64 may enter the first reduced-pressure deliveryconduit 76 via the reduced-pressure interface 72. In another embodiment,the reduced-pressure, abdominal treatment system 30 may exclude thereduced-pressure interface 72 and the first reduced-pressure deliveryconduit 76 may be inserted directly into the sealing member 66 and intothe manifold 64. The first reduced-pressure delivery conduit 76 may be amedical conduit or tubing or any other means for transporting a reducedpressure. The first reduced-pressure delivery conduit 76 may be amulti-lumen member for readily delivering reduced pressure and removingfluids. In one embodiment, the first reduced-pressure delivery conduit76 is a two-lumen conduit with one lumen for fluid transport and one forpressure sensing in fluid communication with a pressure sensor. Inanother embodiment, the first reduced-pressure conduit 76 may be twoseparate conduits or a single conduit having two or more lumens.

Reduced pressure may be supplied to the first reduced-pressure deliveryconduit 76 by the reduced-pressure supply subsystem 62, which includes areduced-pressure source 77. A wide range of reduced pressures may bedeveloped, such as from −50 mm Hg. to −500 mm Hg and more typically inthe range of −100 mm Hg to −300 mm Hg. The pressure developed may beconstant or varied over time. In one illustrative embodiment, thereduced-pressure source 77 includes preset selectors for −100 mm Hg,−125 mm Hg, and −150 mm Hg. The reduced-pressure source 77 may alsoinclude a number of alarms, such as a blockage alarm, a leakage alarm, acanister full alarm, or a battery-low alarm. The reduced-pressure source77 could be a portable source, a wall source, a vacuum pump or otherunit. The reduced-pressure supply subsystem 62 may need to accommodatefluid removal of as much as five liters or more per day.

A number of different devices, e.g., representative device 78, might beadded to a medial portion 80 of the first reduced-pressure-deliveryconduit 76. For example, the representative device 78 may be a fluidreservoir, or canister collection member, a pressure-feedback device, avolume detection system, a blood detection system, an infectiondetection system, a filter, a port with a filter, a flow monitoringsystem, a temperature monitoring system, etc. Multiple devices, e.g.,representative device 78 may be included. Some of these devices, e.g.,the fluid collection member, may be formed integrally with thereduced-pressure source 77. For example, a reduced-pressure port 82 onthe reduced-pressure source 77 may include a filter member (not shown)that includes one or more filters and may include a hydrophobic filterthat prevents liquid from entering an interior space.

Open-Cavity Treatment Subsystems and Treatment Devices

The open-cavity treatment subsystem 52 is for treating the abdominalcavity 32 or the tissue site 34. The open-cavity treatment subsystem 52will now be presented in more detail.

Referring to FIGS. 1-5, the open-cavity treatment subsystem 52 includesthe open-cavity treatment device 50 that is disposed within theabdominal cavity 32. The open-cavity treatment device 50 includes aplurality of encapsulated leg members 90 that may be coupled to anon-adherent drape 108. The non-adherent drape and plurality ofencapsulated leg members 90 are supported by the abdominal contents 46.One or more of the plurality of encapsulated leg members 90 may beplaced in or proximate a first paracolic gutter 92, and one or more ofthe plurality of encapsulated leg members 90 may be placed in orproximate a second paracolic gutter 94. Alternatively or in addition,the plurality of encapsulated leg members 90 may be placed at otherdesired locations, e.g., pelvic cavity, behind the liver, etc. Each ofthe plurality of encapsulated leg members 90 are coupled to the centralconnection member 96. The plurality of encapsulated leg members 90 andthe central connection member 96 are in fluid communication. Both theplurality of encapsulated leg members 90 and the central connectionmember 96 are formed with fenestrations 98, 100, 102, 104 that allowfluids in the abdominal cavity 32 to pass. The fenestrations 98, 100,102, 104 may take any shape, such as circular openings, rectangularopenings, polygons, etc., but are presented in this illustrativeembodiment as slits (elongated openings).

The open-cavity treatment device 50 includes the non-adherent drape 108that may be formed of any non-adherent film material that helps preventtissue from adhering to the non-adherent drape 108. In one embodiment,the non-adherent drape 108 is formed from a breathable polyurethanefilm. The non-adherent drape 108 is formed with a plurality offenestrations 110, which may take any shape. The open-cavity treatmentdevice 50 includes the central connection member 96 to which theplurality of encapsulated leg members 90 are coupled. The centralconnection member 96 may be encapsulated, including the edges of thecentral connection member 96, except at leg coupling areas 112 thatallow fluid communication with the encapsulated leg members 90. Thecentral connection member 96 has apertures or fenestrations, e.g.,apertures 104, which allow fluid communication between a connectionmanifold member 114 and the manifold 64. The fluid communication betweenthe connection manifold member 114 and the manifold 64 may be via thedeep-tissue closure device 54.

Each of the encapsulated leg members 90 may be formed with a pluralityof defined leg modules, such as leg modules 116. A manipulation zone 118may be located between adjacent leg modules 116. The manipulation zones118 facilitate movement of the open-cavity treatment device 50 andcutting of the open-cavity treatment device 50 to size the open-cavitytreatment device 50.

Each encapsulated leg member 90 has a leg manifold member 120, which maybe a single manifold member that runs between the leg modules 116 or maybe formed with discrete components of a manifold material that make upthe leg manifold member 120. The leg manifold member 120 is disposedwithin an interior portion 122 of the encapsulated leg member 90. Theleg manifold member 120 has a first side 124 and second, inward-facing(patient-facing) side 126. A first leg encapsulating member 128, whichis formed with the fenestrations 98, is disposed on the first side 124of the leg manifold member 120. Similarly, a second leg encapsulatingmember 130, which has fenestrations 100, is disposed on the second,inward-facing side 126 of the leg manifold member 120. The second legencapsulating member 130 may be a portion of the non-adherent drape 108.As shown in the longitudinal cross section of FIG. 2 by arrows 132,fluid may flow between the adjacent leg modules 116. As shown by arrows134, fluid is able to enter the fenestrations 98 and 100 and flow intothe leg manifold member 120 and then flow toward the central connectionmember 96 as represented by the flow arrows 132.

Referring now primarily to FIG. 3, a lateral cross section of theencapsulated leg member 90 is presented. As before, it can be seen thatthe first side 124 of the leg manifold member 120 is covered with thefirst leg encapsulating member 128 and that the second, inward-facingside 126 of the leg manifold member 120 is covered by the second legencapsulating member 130. It should be noted that the first legencapsulating member 128 and the second leg encapsulating member 130 maybe a single sheet folded over the leg manifold member 120 and sealed. Inthe illustrative embodiment, the second leg encapsulating member 130 isa portion of the non-adherent drape 108. The leg manifold member 120 hasperipheral edges 136 that are also covered by a portion of the first legencapsulating member 128. The peripheral edges 136 include a firstlateral edge 137 and a second lateral edge 139. The first legencapsulating member 128 covers the first side 124 and the peripheraledges 136 and extends onto a first surface 138 of the non-adherent drape108 and thereby forms extensions 140. The extensions 140 are coupled tothe second leg encapsulating member 130 by any attachment device, e.g.,welding (e.g., ultrasonic or RF welding), bonding, adhesives, cements,etc., and in this example by welds 142.

Referring now primarily to FIG. 4, a schematic cross section of aportion of the central connection member 96 is shown. The centralconnection member 96 is formed with the connection manifold member 114that is encapsulated with a first connection encapsulation member 146,which has fenestrations 102, and a second connection encapsulationmember 152, which has fenestrations 104. The first connectionencapsulation member 146 is disposed on a first side 148 of theconnection manifold member 114. A second, inward-facing side 150 ofconnection manifold member 114 has the second connection encapsulationmember 152 disposed proximate to the second, inward-facing side 150.With reference primarily to FIGS. 4 and 5, the first connectionencapsulation member 146 has a peripheral edge 154. In a similarfashion, the second connection encapsulation member 152 has a peripheraledge that corresponds with the peripheral edge 154 of the firstconnection encapsulation member 146. The peripheral edge 154 of thefirst connection encapsulation member 146 is coupled to the peripheraledge of the second connection encapsulation member 152, except at theleg coupling areas 112 in order to provide flow channels for fluidwithin the encapsulated leg members 90 to flow into the connectionmanifold member 114 as suggested by reference arrows 156 in FIG. 4.Fluid may also enter directly into the connection manifold member 114 byflowing through the fenestrations 104 as suggested by arrows 158.

The deep-tissue closure device 54 is deployed proximate to the firstconnection encapsulation member 146. When reduced pressure is applied tothe manifold 64, the reduced pressure is communicated through thedeep-tissue closure device 54 and that causes fluid to flow from theconnection manifold member 114 through the fenestrations 102, throughthe deep-tissue closure device 54, and into the manifold 64 as issuggested by arrows 160. The fluid continues to flow in the direction ofthe reduced-pressure interface 72 and from there flows to the firstreduced-pressure delivery conduit 76.

Referring primarily now to FIGS. 6-8, another illustrative embodiment ofan open-cavity treatment device 202, which might be used with thereduced-pressure, abdominal treatment system 30 of FIG. 1, is presented.The open-cavity treatment device 202 is analogous in most respects tothe open-cavity treatment device 50 of FIGS. 1-5. The open-cavitytreatment device 202 has a non-adherent drape 204, a plurality ofencapsulated leg members 206, and a central connection member 208. Inthis illustrative embodiment, the non-adherent drape 204 is formed withan oval or arcuate shape, but various shapes are possible. Thenon-adherent drape 204 is formed with a plurality of fenestrations 205therethrough. The non-adherent drape 204 also forms a second legencapsulating member 228 and a second connection encapsulation member(not shown, but see by analogy 152 in FIG. 4), and the fenestrations 205in the non-adherent drape 204 serve as flow channels for theencapsulated leg members 206 and the central connection member 208 onthe second, inward-facing side.

Each of the plurality of encapsulated leg members 206 may be formed witha plurality of leg modules 210 with manipulation zones 212 betweenadjacent leg modules 210. The manipulation zones 212 facilitatemaneuvering of the plurality of encapsulated leg members 206 within theabdominal cavity and provide an easier location at which to cut theencapsulated leg members 206 when the open-cavity treatment device 202is being sized. In this regard, visual indicia 214 may be added on thenon-adherent drape 204 to help the healthcare provider know where to cutthe non-adherent drape 204 for different sizes of application within theabdominal cavity. The visual indicia 214 may include cut lines formedwith biocompatible ink or welds or fenestrations or other markings thatrun, at least in part, through the manipulation zones 212. The visualindicia 214 may also show size graduations.

Referring now primarily to FIG. 8, a lateral cross section of theencapsulated leg member 206 is presented. The encapsulated leg members206 are formed with a leg manifold member 218 having a first side 220and a second, inward-facing side 222. A first leg encapsulating member224 covers the first side 220 of the leg manifold member 218 and coverslateral edges 226 of the leg manifold member 218. The second,inward-facing side 222 of the leg manifold member 218 is covered by asecond leg encapsulating member 228, which in this embodiment is aportion of the non-adherent drape 204. The first leg encapsulatingmember 224 is coupled to the second leg encapsulating member 228 by anymeans known in the art, e.g., welding (e.g., ultrasonic or RF welding),bonding, adhesives, cements, etc. In this illustration, the first legencapsulating member 224 is coupled to the second leg encapsulatingmember 228 by a weld 230. The weld 230 may be formed on a perimeterportion of each leg module 210 or elsewhere.

The central connection member 208 is formed analogously to the centralconnection member 96 in FIG. 4. The first connection encapsulationmember 234 and the second connection encapsulation member (not shown butanalogous to second connection encapsulation member 152 in FIG. 4) arecoupled along a peripheral edge 232 using a weld 233 or other couplingmeans, e.g., welding (e.g., ultrasonic or RF welding), bonding,adhesives, cements, etc. The peripheral edge 232 of the firstencapsulation member 234 and the second encapsulation member are notcoupled in a way that closes off fluid flow between the encapsulated legmembers 206 and the central connection member 208; that is, a flow pathfor fluids to flow from the encapsulated leg members 206 into thecentral connection member 208 exists.

According to one illustrative approach to constructing the open-cavitytreatment device 202, the non-adherent drape 204 that is formed withfenestrations 205 and that may have visual indicia 214 is placed on asubstantially flat surface or otherwise presented on a plane. The legmanifold members 218 are placed onto the non-adherent drape 204. Thecentral connection member 208 is placed on the non-adherent drape 204.Alternatively, the central connection member 208 may be formed as anintegral member with the leg manifold members 218, and in that case, thecentral connection member 208 and the leg manifold members 218 would beplaced simultaneously. The first connection encapsulation member 234 isplaced on the central connection member 208, and the first legencapsulating member 224 is placed on first side, or top (for theorientation shown in FIG. 6), of the leg manifold members 218. Thenwelds 230 and 233 are applied. Thus, the open-cavity treatment device202 is formed.

In an alternative embodiment, a first non-adherent drape 204, whichincludes fenestrations 205, may have the leg manifold members 218 andthe central connection member 208 placed on the first non-adherent drape204. Then, a second non-adherent drape, which has fenestrations, isplaced over the first non-adherent drape 204, the leg manifold members218, and the central connection member 208. Then a plurality of welds(e.g., thermal or RF) are made, and the perimeter of the twonon-adherent drapes may be welded. In addition, other points on thedrape may be welded together. In another alternative, the twonon-adherent drapes may initially not have fenestrations, andfenestrations may be added separately to the non-adherent drapes afterassembly so that the fenestrations line up. The fenestrations may alsobe formed with an electrical member that cuts and seals simultaneouslyto form “button hole” fenestrations through the two non-adherent drapesat the locations where the leg manifold and the central connectionmember are absent.

Referring now to FIG. 9, another illustrative embodiment of anopen-cavity treatment device 302 is presented. The open-cavity treatmentdevice 302 is similar in most respects to that of the open-cavitytreatment device 202 shown in FIG. 6. The open-cavity treatment device302 has a plurality of encapsulated leg members 306 and a centralconnection member 312 on a non-adherent drape 348. The open-cavitytreatment device 302 differs from the open-cavity treatment device 202primarily in that a fluid delivery subsystem 345 has been added. Thefluid delivery subsystem 345 allows various fluids, such as medicines orirrigation fluids, to be delivered into the abdominal cavity. Thevarious fluids may then be removed by the action of the plurality ofencapsulated leg members 306 and the open-cavity treatment device 302itself. The fluid delivery subsystem 345 includes a central port member347, which may be placed on or in the central connection member 312, forconnecting to a delivery conduit (not shown) that delivers the fluidfrom a site external to the abdominal cavity to the central port member347. Fluidly coupled to the central port member 347 is a plurality offluid-delivery conduits 349. The fluid-delivery conduits 349 may runanywhere on the non-adherent drape 348. For example, the fluid-deliveryconduits 349 may run along the sides of the encapsulated leg members 306or on the opposite side of the non-adherent drape 348. In thisillustrative embodiment, the fluid-delivery conduits 349 are shownrunning through the plurality of encapsulated leg members 306. Thefluid-delivery conduits 349 are open on their distal ends 351 to allowthe delivery of fluid there through. However, fluid delivery conduits349 may have apertures at various locations for deliverying fluid andmay be closed at the distal ends 351 or open at the distal ends 351. Theflow of fluid through the distal ends 351 of the fluid-delivery conduits349 is suggested by arrows 353.

In use, the open-cavity treatment device 302 may be used in a fashionanalogous to that of the open-cavity treatment devices 50 and 202, butat various times, it may be desirable to deliver a fluid through thefluid delivery subsystem 345. For example, it may be desirable to flushthe abdominal cavity with an irrigation fluid or to deliver periodicdoses of medicine.

Deep-Tissue Closure Subsystems and Devices

Referring to FIG. 1, the deep-tissue closure subsystem 56 of thereduced-pressure, abdominal treatment system 30 may be used for closingdeep tissues, such as the fascia 36 and, in particular, to approximatethe fascia edges 38. The deep-tissue closure subsystem 56, whichincludes the deep-tissue closure device 54, is shown. The deep-tissueclosure subsystem 56 is particularly well suited for use within theabdominal cavity 32 that involves a deep tissue, such as in the fascia36. The wound in the fascia 36 is shown with fascia edges 38 thattypically define the deep-tissue wound. It is desirable to close orapply a closing force on the deep-tissue wound by proximating the fasciaedges 38. As will be described in more detail, the deep-tissue closuredevice 54 helps with this purpose.

The deep-tissue closure device 54 may be placed on top of theopen-cavity treatment device 50 and underneath the fascia 36. Referringprimarily to FIGS. 1 and 10, the deep-tissue closure device 54 includesa contractible matrix 164, which has a first side 166 and a second,inward-facing side 168. The contractible matrix 164 is formed with afirst plurality of apertures 170 through a contractible matrix materialor structure. The contractible matrix 164 may also be formed so that aplurality of cells, e.g., open cells 172, is formed on the second,inward-facing side 168. The plurality of cells 172 may be formed withcell walls 174, which may include a second plurality of apertures 176.The first plurality of apertures 170 may be centered on the cells 172.

When reduced pressure is delivered to the contractible matrix 164, agripping force is developed and an inward force. The reduced pressureacts through the first plurality of apertures 170 to provide a grippingforce on the fascia 36. The gripping force holds, or grips, the fascia36. The reduced pressure may be supplied to the fascia 36 fromunderneath (for the orientation shown) via fluid communication with theopen-cavity treatment device 50, the cells 172, and the first pluralityof apertures 170. Reduced pressure may additionally or alternatively besupplied via the manifold 64 and the second plurality of apertures 176.The gripping force on the fascia 36 is represented by arrows 178.

In addition to providing a gripping force through the apertures 170, thereduced pressure also urges the contractible matrix 164 inward, i.e., inthe direction shown by arrows 29. “Inward” in this context means towarda center portion of the reduced-pressure, deep-tissue closure device 54.Alternatively, “inward” may be defined as in a direction that would pullthe tissue, e.g., the fascia 36, towards the fascia edges 38 of thetissue wound for a deployed reduced-pressure, deep-tissue closure device54. As the reduced pressure acts on the contractible matrix 164, thecontractible matrix 164 grips the fascia 36 and goes from anon-contracted position to a contracted position. In one embodiment, thecontractible matrix 164 includes cells that collapse laterally andthereby contract. The side walls, which are flexible, of the cells movecloser to one another under the influence of reduced pressure. Becausethe reduced pressure on the first plurality of apertures 170 grips thefascia 36, and the reduced pressure also causes the contractible matrix164 to contract, a closing force is developed and applied to the fascia36 that urges the fascia edges 38 into closer approximation. Thus, thefascia 36 experiences a closing force and can be closed or urged into aclosed position using reduced pressure.

In one embodiment, the contractible matrix 164 includes a plurality ofcells, e.g., cells 172, that collectively define a first volume (V₁)when no reduced pressure is applied, e.g., at ambient pressure. Whenreduced pressure is applied to the cells, the cells collapse orotherwise move such that a second volume is defined (V₂). The secondvolume is less than the first volume (V₁), i.e., V₁>V₂, and this changein volume is associated with contraction.

The deep-tissue closure subsystem 56 is able to provide a closing forceon deep tissue, such as fascia 36, and to help provide reduced-pressuretreatment within the abdominal cavity 32 and, in particular, to providereduced-pressure treatment proximate the tissue site 34. The reducedpressure may be applied to the tissue site 34 and the abdominal cavity32 to help promote removal of ascites, exudates or other liquids. Thereduced pressure may be applied also to stimulate the growth ofadditional tissue.

In using the deep-tissue closure subsystem 56, a number of differentembodiments of the deep-tissue closure device 54 may be used.Functionally, it is desirable for the deep-tissue closure device 54 togrip the deep tissue without puncturing the deep tissue and to pull thedeep tissue towards the center, e.g., toward the center of a deep-tissuewound 165. When applied to the fascia 36, the deep-tissue closure device54 approximates the fascia edges 38.

Referring primarily now to FIGS. 11 and 12, a contractible matrix 400for use as part of a reduced-pressure, deep-tissue subsystem ispresented. The contractible matrix 400 has a first side 402 and asecond, inward-facing side 404. FIG. 11 presents the first side 402, andFIG. 12 presents the second, inward-facing side 404. In this particularillustrative embodiment, the contractible matrix 400 is formed with asolid circular shape, but numerous other shapes, such as the ellipticalshape shown in FIG. 13, an arcuate shape, a rectangular shape, anirregular shape, etc., may be used. The first side 402 of thecontractible matrix 400 has a first plurality of apertures 406 formedthere through and that extend to the second, inward-facing side 404. Asshown in FIG. 12, a plurality of cells 408 is formed on the second,inward-facing side 404. The cells 408 each have an aperture 406 and anopen cell portion. Each open cell 408 is formed with cell walls 410.Each cell wall 410 may have an intercellular aperture through the cellwall 410 to form a second plurality of apertures analogous to the secondplurality of apertures 176 in FIG. 10. In this particular illustrativeembodiment, the plurality of cells 408 may be formed as honeycomb cellscentered around each of the first plurality of apertures 406. Othershapes for the cells 408 are possible as mentioned further below.

Referring now to FIGS. 13-14, another illustrative embodiment of acontractible matrix 500 is presented. The contractible matrix 500 has afirst side and a second, inward-facing side 504. The contractible matrix500 in this particular illustrative embodiment is formed with an ovalshape that has a central opening 506, but as shown in FIG. 11 could beformed without such an opening. As shown in FIG. 14, the second,inward-facing side 504 of the contractible matrix 500 may be formed witha plurality of cells 508, each centered on a first plurality ofapertures 510. The plurality of cells 508 may be formed by a pluralityof interconnected cell walls 512. The cell walls might be formed with asecond plurality of apertures formed through the cell wall analogous tothe second plurality of apertures 176 in FIG. 10.

Referring now to FIG. 15, another illustrative embodiment of acontractible matrix 520 is presented. The contractible matrix 520 may beused in the reduced-pressure, deep-tissue closure subsystem 56 ofFIG. 1. The contractible matrix 520 in this illustrative embodiment isrectangular in shape and has a first plurality of apertures 522 that gofrom a first side 524 to a second, inward-facing side 526 of thecontractible matrix 520. A second plurality of apertures 528 may connectthe first plurality of apertures 522 or some portion thereof.

In an alternative embodiment, the contractible matrix 520 may haveapertures 522 on the first side 524 but no corresponding aperture on thesecond, inward-facing side 526. Thus, the contractible matrix 400 hascells that open only to the first side 524 and may have apertures 528,which provide reduced pressure into the cells. When reduced pressure issupplied through apertures 528, the deep tissue is gripped by theapertures 522 and the side walls of the cells are pulled into closerproximity causing the contractible matrix 520 to contract.

A number of different substances might be used to form the contractiblematrices, e.g., the contractible matrix 164 of FIG. 1, the contractiblematrix 400 of FIGS. 11 and 12, the contractible matrix 500 of FIGS. 13and 14, and the contractible matrix 520 of FIG. 15. Typically, aflexible, contractible material is used for the matrices. For example,these contractible matrices 164, 400, 500, and 520 may be formed fromflexible, thermal plastic elastomers (TPE); thermoplastic urethane(TPU); silicone rubber; etc. Foam is not used for the contractiblematrices. The material from which the contractible matrics are formedpreferably avoid the ingrowth of any tissue. Moreover, a number ofdifferent cell geometries may be utilized in the contractible matrices.For example, the possible cell geometries include honeycomb,round-shaped, diamond-shaped, gear-shaped cells, etc. While foam is notused typically, in one embodiment, the contractible matrix could beformed from a sealed or encapsulated foam member that has apertures forgripping the tissue and a reduced-pressure supply interface.

In one illustrative embodiment, the contractible matrix may be formedwith a TPU honeycomb material that includes honeycomb cells that areformed with fusion bonding. In another illustrative embodiment, thecontractible matrix may be formed from a thermal plastic elastomer (TPE)that allows for expansion and contraction in the xy plane (the planewithin the page for FIG. 13) while holding a fairly constant dimensionin the z direction (coming out of the page on FIG. 13). In thisembodiment, the contractible matrix may have a stronger material (ormore material) concentrated in the z direction than in the xydirections. Alternatively or in addition, voids may be added toprescribe the pattern of collapse. Alternatively or in addition,strengthening members, e.g., filaments, may be added in the z directionto avoid collapse in that direction. In another illustrative embodiment,the contractible matrix may be formed using a thermoplastic urethane(TPU) material that may have an additional film on the contractiblematrix on the first side, e.g., on first side 402 of the contractiblematrix 400 of FIG. 11. These are only some illustrative examples.

Surface-Wound Closure Subsystems

Referring again to FIG. 1, the surface-wound closure subsystem 60 is nowpresented. It is desirable to help provide a closing force to thesurface wound 180 on the epidermis 44 and, in particular, between thesurface-wound edges 182. As shown in FIGS. 1 and 16, the surface-woundclosure subsystem 60 may be used for this purpose. The surface-woundclosure subsystem 60 develops a closing force represented by arrows 184that is communicated to the epidermis 44 and urges the surface-woundedges 182 towards each other. The surface-wound closure subsystem 60 mayinclude a first attachment member 186 that has a first base member 177and a first wall 188, or wall member, (FIG. 16). The sealed contractingmember 196 may be secured to the wall 188 by a securing device, e.g.,adhesive 189. The first base member 177 has a first side 190 and asecond, inward-facing side 191. The first base member 177 and the firstwall 188 may be made from numerous materials, but a material ispreferred that provides some flexibility. For example, the firstattachment member 186 may be formed with the first base member 177 andthe first wall 188 made from polypropylene, or a rigid silicone, etc.

A first adhesive 192 may be applied to the second, inward-facing side191 of the first base member 177 to allow the first base member 177 tobe releasably attached directly to a portion of a patient's epidermis 44or indirectly if a polyurethane film or other sealing member 66 isplaced on the epidermis 44 first. In addition to the first adhesive 192,staples, or sutures, or other invasive approaches might be used toattach the first base member 177. The first attachment member 186 may beapplied directly on top of the epidermis 44, or on top of the sealingmember 66, so that whatever forces are applied on the first attachmentmember 186 are transmitted directly, or indirectly, to the epidermis 44.References to applying the first attachment member 186 to the epidermis44 should be deemed to include application on top of the sealing member66 as well.

Across the surface wound 180 from the first attachment member 186 is asecond attachment member 193. The second attachment member 193 isanalogous to the first attachment member 186. While the surface-woundclosure subsystem 60 of FIG. 1 only shows two attachment members 186,193, other attachment members may be dispersed around the surface wound180 in a spaced fashion and typically in pairs. Having at least twoattachment members, e.g., attachment members 186 and 193, allows theclosing force to be developed.

One or more of the attachment members, e.g., attachment member 186, hasa reduced-pressure interface 194 for receiving reduced pressure from asecond reduced-pressure delivery conduit 195. For example, as shown inFIG. 16, the first attachment member 186 may include thereduced-pressure interface 194 to which the second reduced-pressuredelivery conduit 195 is fluidly coupled.

The surface-wound closure subsystem 60 includes a sealed contractingmember 196. The sealed contracting member 196 may be formed from thesame type of materials as the manifold 64, but it may be desirable toinclude a material that has fewer apertures or holes through thematerial. The sealed contracting member 196 may be formed from acontracting manifold material that is enveloped by a first sealingmember 181 and a second sealing member 183. In addition, it may bedesirable in some situations to have a material that will contract lessin the vertical (for the orientation shown in FIG. 1) and more in thehorizontal plane (for the orientation shown FIG. 1). The sealedcontracting member 196 has a first side 197 and a second, inward-facingside 198. The sealed contracting member 196 also has a peripheral edge199.

The sealed contracting member 196 may be sealed by having the firstsealing member 181 (FIG. 16) applied to the first side 197, and thesecond sealing member 183 applied to the second, inward-facing side 198.The peripheral edge 199 may be sealed by a peripheral sealing member 185having a surface 200 disposed against the peripheral edge 199. The wall188 may also be used to the seal peripheral edge 199. Similarly, thesecond, inward-facing side 198 may be sealed by placement against thesealing member 66 or the patient's epidermis 44. The sealed contractingmember 196 might also be sealed by being coated with a gas-imperviousmaterial. The sealed contracting member 196 may be sealed usingpolyurethane film or silicone as the sealing members 181, 183 and thenultrasonically welding or RF welding the ends of the sealing members181, 183 to cover the peripheral edge 199. When reduced pressure issupplied to the sealed contracting member 196, the sealed contractingmember 196 contracts to develop the closing force, which is representedby the arrows 184.

The sealed contracting member 196 may be formed with an opening 187(FIG. 1) on a portion of the sealed contracting member 196 for receivingan extension portion 179 of the reduced-pressure interface 72. Theextension portion 179 extends through the sealed contracting member 196and into the manifold 64.

There are many ways of developing the reduced pressure to be used withthe surface-wound closure subsystem 60. In the illustrative embodimentshown, the reduced-pressure supply subsystem 62 (FIG. 1) may have asecond reduced-pressure source 84 that delivers reduced pressure to thesecond reduced-pressure delivery conduit 195, which delivers the reducedpressure to the second reduced-pressure interface 194. As suggested byconduit 86 (shown in broken lines), the second reduced-pressure source84 could be used to provide reduced pressure to the firstreduced-pressure delivery conduit 76 (in addition to or in lieu of firstreduced-pressure source 77) as well as to the second reduced-pressuredelivery conduit 195. Alternatively, the first reduced-pressure source77 could supply reduced pressure through conduit 86 to the secondreduced-pressure conduit in addition to or in lieu of the secondreduced-pressure source 84.

Referring now to FIG. 17A, a surface-wound closure device 600 forproviding a closing force on a surface wound, e.g., surface wound 180 inFIG. 1, is presented. The surface-wound closure device 600 may be usedas the surface-wound closure subsystem 60 of FIG. 1. The surface-woundclosure device 600 has a plurality of attachment members: a firstattachment member 602, a second attachment member 604, a thirdattachment member 606, and a fourth attachment member 608. Eachattachment member 602, 604, 606, 608 has an attachment device forreleasably attaching the member to the patient's epidermis (or to asealing member). For example, the first attachment member 602 includesan attachment device that is an adhesive 610 for attachment to thepatient's epidermis and similarly, third attachment member 606 has anadhesive 612. While not shown, the second and fourth attachment membersalso have an attachment device, such as an adhesive, for securing themembers to a patient's epidermis. While non-invasive means are generallyconsidered preferable, it may also be that the attachment members 602,604, 606, 608 may be secured using sutures, staples, or other invasivemechanical devices.

A wall 614, which is coupled to the plurality of attachment members,forms a circumferential wall having an interior space into which acontracting member 616, or contracting material, is placed. Thecontracting member 616 is attached to the circumferential wall 614 atleast at points proximate to each attachment member 602, 604, 606, 608.The circumferential wall 614 may be made of polypropylene, rigidsilicone, or other semi-rigid material that allows the circumferentialwall 614 to flex when in a closing mode, i.e., when reduced pressure isapplied. The contracting member 616 may be made of the same kind ofmaterials as sealed contracting member 196 in FIG. 1. The contractingmember 616 in operation should be sealed and may be sealed by films,layers, or drapes being applied to a first side 618, or top side (forthe orientation shown). The contracting member 616 may also be sealedwith the circumferential wall 614 covering the peripheral edge, thesealing member may provide a seal on the bottom, and then a film ordrape placed over the top. The contracting member 616 may simply beenveloped in a polyurethane film that has been welded to form anenvelope around the material. An opening 620 may be formed through thecontracting member 616. The opening 620 is for placement of part of areduced-pressure interface, or port, extending to a manifold below thesurface-wound closure device 600. A reduced-pressure conduit 622delivers reduced pressure into the contracting member 616; this may beaccomplished by directly applying the reduced-pressure conduit 622 intoany portion of the contracting member 616, but is shown using areduced-pressure interface 624 formed on a portion of thecircumferential wall 614.

In operation, the attachment members, e.g., first attachment member 602and second attachment member 604, are placed opposite each other and oneach side of a surface wound and releasably attached. Thus, for example,the first attachment member 602 and the fourth attachment member 608 maybe releasably secured to one side of a surface wound at different spacedportions and the attachment members 604 and 606 may be placed on theother side of the surface wound. As the surface-wound closure device 600is installed, the surface-wound closure device 600 is in anon-contracted position.

Once the surface-wound closure device 600 is installed on the surfacewound, reduced pressure is supplied to the reduced-pressure conduit 622.The contracting member 616 contracts under the supplied reduced pressurecausing at least portions of the circumferential wall 614 to be pulledtowards a central portion, and in turn, to develop the forcestransmitted to the attachment members which pull towards each other.Thus, a net closing force is developed and transmitted to the epidermisthrough the attachment members 602, 604, 606, and 608. FIG. 17B showsthe surface-wound closure device 600 in a top view and in anon-contracted position, and FIG. 17C shows the surface-wound closuredevice 600 in the contracted position.

Referring now to FIGS. 18 to 21B, a modular, reduced-pressurewound-closure system 700, which is suitable as another illustrativeembodiment of a surface-wound closure subsystem 60, is presented. Themodular, reduced-pressure wound-closure system 700 uses a number ofmodular components that may be movably coupled to accommodate varioussizes and shapes of wounds and to provide a closing force directedtoward a central portion of the surface wound. Referring initially toFIG. 18, a plurality of attachment-base members, such as attachment-basemember 702, may be used. The attachment-base member 702 has a base 704,which has a first side 706 and a second, inward-facing side 708. Thesecond, inward-facing side 708 of the base 704 may have an adhesive (notshown but analogous to 610 in FIG. 17A) for attaching theattachment-base member 702 to a patient's epidermis (or to a sealingmember). The adhesive on the second, inward-facing side 708 may beinitially covered with a releasable backing material that may be removedbefore application on the patient. The attachment-base member 702 alsoincludes a wall 710 that is coupled to the base 704 or formed integrallywith the base 704. The wall 710 has a first end 712 and a second end714. The first end 712 may be formed with a first movable connectionmember 716 that is formed as an integral part or attached to the firstend 712. The second end 714 may be formed with a second movableconnection member 718. The wall 710 or base 704 may have a hook member720 attached to the wall 710 or base 704. The hook member 720 may beused to help grip and hold a sealed contracting member 722 (see FIG.21A).

Referring now to FIG. 19, a plurality of connecting members, such asconnecting member 726, may be used as part of the modular,reduced-pressure wound-closure system 700. Each connecting member 726has a second wall 728 with a first end 730 and a second end 732. Thesecond wall 728 may be shaped to have an arcuate configuration as shownor may be straight. The first end 730 may be formed with, or havecoupled to the first end 730, a third movable connection member 734.Similarly, the second end 732 may have a fourth movable connectionmember 736. The movable connection members 734 and 736 are sized andconfigured to cooperate with movable connection members, e.g., movableconnection members 716 and 718, in a coordinated fashion that allowsrelative movement, such as pivotable movement, between eachattachment-base member 702 and each adjacent, coupled connecting member726. In this particular illustrative embodiment, the movable connectionmembers 734 and 736 are shown as being pin-shaped members. The first andsecond movable connection members 716 and 718 are sockets that are sizedand configured to receive the pin shapes of movable connection members734 and 736.

While a reduced-pressure conduit, such as conduit 622 in FIG. 17A, mightbe applied directly into the attachment-base member 702 through the wall710, a reduced-pressure interface might be used on the wall 710 of theattachment-base member 702. Thus, for example, the attachment-basemember 702 might be modified to form a reduced-pressure interface member740 as shown in FIG. 20. The reduced-pressure interface member 740 isanalogous to that of the attachment-base member 702 except that areduced-pressure interface 742 has been included. The reduced-pressureinterface 742 may be a port 744 that extends through a wall 746.

The previously presented modular components, attachment-base member 702,connecting member 726, and reduced-pressure interface member 740, may becombined to form various shapes; one example is shown in FIGS. 21A and21B with the modular, reduced-pressure wound-closure system 700 shownaround and over a surface wound 701. With reference primarily to FIG.21A, the modular, reduced-pressure wound-closure system 700 is shownwith a plurality of attachment-base members. In this instance, themodular, reduced-pressure wound-closure system 700 includes the firstattachment-base member 702, a second attachment-base member 750, and athird attachment-base member 752. A fourth attachment-base member isshown, but has been modified to form the reduced-pressure interfacemember 740, which has the reduced-pressure interface 742. Areduced-pressure conduit 754 may be coupled to the reduced-pressureinterface 742.

A plurality of movable connecting members is used to connect each of theplurality of attachment-base members 702, 750, 752, 740 (interface).Thus, in this illustrative embodiment, the attachment-base member 702 ismovably coupled at the first end 712 to the first connecting member 726at the second end 732 of the first connecting member 726. Similarly, thesecond attachment-base member 750 is movably coupled to the secondconnecting member 756. The second connecting member 756 is also movablycoupled to the third attachment-base member 752. At the same time, thethird attachment-base member 752 is movably coupled to a thirdconnecting member 758, which is also movably coupled to thereduced-pressure interface member 740. The reduced-pressure interfacemember 740 is also movably coupled to a fourth connecting member 760. Inthis way the plurality of attachment-base members and plurality ofconnecting members form a circumferential wall 780 defining an interiorspace 781 into which sealed contracting member 722 is disposed.

It will be appreciated that the alternating members of the plurality ofattachment-base members and plurality of connecting members provide forconnections that move and are thus movably coupled. Movably coupling themembers is helpful when the modular, reduced-pressure wound-closuresystem 700 goes from the non-contracted position of FIG. 21A to thecontracted position shown in FIG. 21B. It will also be appreciated thatwhile only four connecting members and four attachment-base members areshown in this illustration, any number of these components might be usedfor bigger or smaller applications. For example, a modular,reduced-pressure closure system 800 in FIG. 22 shows a much largersystem configuration.

The modular, reduced-pressure closure system 800 in this illustrativeembodiment includes a plurality of attachment-base members having sevenattachment-base members 802 and another that has been modified to form areduced-pressure interface 804. The modular, reduced-pressure closuresystem 800 also includes a plurality of connecting members, which inthis illustrative embodiment includes eight connecting members 806. Theplurality of attachment-base members 802 and the plurality of connectingmembers 806 are movably coupled to form a circumferential wall 808 thatdefines an interior space 810. A sealed contracting member 812 is placedwithin the interior space 810 and is coupled to at least the pluralityof attachment-base members 802. When reduced pressure is suppliedthrough a reduced-pressure interface 814 on the reduced-pressureinterface 804, the reduced pressure causes the sealed contracting member812 to contract and pulls each of the plurality of attachment-basemembers 802 toward a central portion. Thus providing a closing force.

Referring now to FIGS. 23A and 23B, one illustrative embodiment of areduced-pressure connector 900 is presented. The reduced-pressureconnector 900 is operable to fluidly connect two different compartmentsor areas. In the illustrative embodiment of FIGS. 23A and 23B, thereduced-pressure connector 900 has a first end 902 and a second end 904.An entry portion 906 is formed on the second end 904. The entry portion906 may be shaped as an inverted conical section to facilitate insertionthrough various materials, such as sealing members and manifolds. On thefirst end 902, a plurality of flutes 908 may be located to facilitatefluid flow. A flange portion 910 may be formed between the first end 902and the second end 904. The flange portion 910 has a first surface 912and a second surface 914. In an alternative embodiment, the first end902 may also be shaped and configured for easy entry through a sealingmember or other material. Two different, illustrative applications ofthe reduced-pressure connector 900 are shown in FIGS. 24A and 24B.

Referring to FIG. 24A, a portion of a reduced-pressure, wound-closureand treatment system 1000 is presented. The reduced-pressure,wound-closure and treatment system 1000 is analogous in many respects tothe surface-wound closure subsystem 60 of FIG. 1. A manifold 1018 isplaced within a body cavity, e.g., an abdominal cavity 1010, to helpprovide reduced-pressure treatment therein. The manifold 1018 is shownproximate to subdermal tissue 1014 and a surface wound 1011.

A sealing member 1032 is placed on the patient's epidermis 1008 over theabdominal cavity 1010 and the surface wound 1011. The surface wound haswound edges 1012. The sealing member 1032 has an adhesive 1034 thathelps to form a pneumatic seal with the epidermis 1008. The sealingmember 1032 as applied forms a pneumatic seal over the abdominal cavity1010.

A portion 1071 of a wound-closure device or subsystem is also presented.The portion 1071 includes a portion of a sealed contracting member 1088.The sealed contracting member 1088 is sealed, at least in part, by afirst sealing member 1096 and a second sealing member 1098. The sealedcontracting member 1088 is attached, at least at certain portions, tothe patient's epidermis 1008. When reduced pressure is supplied to aninterior of the sealed contracting member 1088, the sealed contractingmember 1088 contracts and thereby pulls towards a central portion anddevelops a closing force that is transmitted to the surface wound 1011.

In the illustrative embodiments of FIGS. 24A and 24B, reduced pressureis supplied by a reduced-pressure source to a reduced-pressure conduit1042. The reduced-pressure conduit 1042 is fluidly coupled to areduced-pressure interface 1038, which has an extension portion 1102. Inthe embodiment of FIG. 24A, the extension portion 1102 extends throughthe sealing member 1032 and into the manifold 1018. Thus, reducedpressure is delivered to the manifold 1018 and pulls fluids towards theextension portion 1102 as suggested by arrows 1044. In this embodiment,the reduced-pressure connector 900 has been added. The reduced-pressureconnector 900 is deployed with the first end 902 within the interior ofthe sealed contracting member 1088 and the second end 904 within themanifold 1018. The reduced-pressure connector 900 thereby fluidlycouples the interior of the sealed contracting member 1088 with themanifold 1018. Reduced pressure is thereby delivered from thereduced-pressure interface 1038, to the manifold 1018, and to theinterior of the sealed contracting member 1088. The reduced pressuredelivered through the reduced-pressure connector 900 pulls fluids withinthe sealed contracting member 1088 as suggested by arrows 1045.

The first surface 912 of the reduced-pressure connector 900 abuts thesealing member 1032 and the second surface 914 abuts the manifold 1018.The reduced-pressure connector 900 may be deployed in numerous ways. Forexample, with reference to FIG. 17A, the reduced-pressure connector 900can be placed over a cell, e.g., cell 625, of the contracting member616, and pushed through the sealing member thereon. The entry portion906 is shaped to facilitate such an entry. The sealing member thereonshould self-seal after insertion, but an additional portion of sealingmaterial could also be added over the insertion point. During insertion,the reduced-pressure connector 900 is pushed into the sealed contractingmember 616 until the second surface 914 abuts the second (bottom fororientation shown) sealing member 1098 and the entry portion 906 extendsout of the contracting member 616. Referring now primarily to FIG. 24A,in a like fashion, the entry portion 906 can then be inserted throughthe sealing member 1032 and into the manifold 1018. As noted earlier,numerous approaches may be taken for deploying the reduced-pressureconnector 900 and the reduced-pressure connector 900 may take manydifferent configurations, but the deployed reduced-pressure connector900 functionally provides a fluid coupling of the sealed contractingmember 1088 and the manifold 1018.

Referring now to FIG. 24B, another alternative is shown. In theembodiment of FIG. 24B, the extension portion 1102 of thereduced-pressure interface 1038 terminates within the sealed contractingmember 1088 and delivers reduced pressure within the sealed contractingmember 1088. The reduced-pressure connector 900 is deployed in the samemanner as previously presented, but now delivers reduced pressure to themanifold 1018. In other words, fluids are drawn through the manifold1018, through the reduced-pressure connector 900, through an interior ofthe sealed contracting member 1088 to the extension portion 1102 of thereduced-pressure interface 1038 and then through the reduced-pressureconduit 1042.

Referring now to FIGS. 25-27, another illustrative embodiment of amodular, reduced-pressure closure system 1200, which is suitable asanother illustrative embodiment of the surface-wound closure subsystem60, is presented. The modular, reduced-pressure closure system 1200includes a spacing member, e.g., a flexible strap 1202, which is shownin a linear position in FIG. 25 and shaped into a closed loop 1204 inFIG. 27. The flexible strap 1202 may be shaped into the closed loop 1204around a surface wound 1206, such as an opening on a patient's abdomen.A plurality of modular closing members 1208 is selectively coupled tothe flexible strap 1202. The number of modular closing members 1208included in the plurality of modular closing members on the flexiblestrap 1202 is determined by the size of the closed loop 1204 needed tosurround the surface wound 1206. Thus, to cover the surface wound 1206in FIG. 27, eight modular closing members 1208 have been included on theflexible strap 1202. While a flexible strap 1202 has been referenced,any spacing member that holds the modular closing members 1208 in aspaced relationship around the surface wound 1206 may be used. Forexample, the spacing member may be one or more tie wires that hold themodular closing members 1208 in a spaced relationship or a flexibleadhesive film placed on top of the modular closing members 1208 thathold the modular closing members 1208 in a spaced relationship.

Referring again primarily to FIG. 25, each of the modular closingmembers 1208 has a first end 1210 and a second end 1212. A connectionmember 1214 is coupled to the first end 1210 of each modular closingmember 1208. In the illustrative embodiment of FIG. 25, each connectionmember 1214 includes an attachment loop 1216 through which the flexiblestrap 1202 may be placed. The attachment loops 1216 allow each modularclosing member 1208 to be positioned in a desired location along theflexible strap 1202. A portion of each attachment loop 1216 mayinterface with one of a plurality of strap openings 1218 to help holdthe connection member 1214 in a desired position on the flexible strap1202.

Referring now primarily to FIG. 26, the second reduced-pressureinterface 1226 is shown coupled to the connection member 1214. Areduced-pressure conduit 1227 is fluidly coupled to the secondreduced-pressure interface 1226 in order to provide reduced pressure tothe second reduced-pressure interface 1226. The second reduced-pressureinterface 1226 delivers the reduced pressure to a sealed contractingmember 1228 and may function as a pin to hold the connection member 1214in place relative to the flexible strap 1202. The secondreduced-pressure interface 1226 may extend through an opening inconnection member 1214, through the attachment loop 1216, through theflexible strap 1202 and into the sealed contracting member 1228. In FIG.26, one may see that the sealed contracting member 1228 may be held to abase 1231 by an adhesive layer 1229. Similarly, a peripheral edge 1233of the sealed contracting member 1228 may be held to a wall 1251 ofconnection member 1214 by an adhesive layer 1235. In this way, reducedpressure can be supplied to the modular closing member 1208 and moreparticularly to the sealed contracting member 1228. FIGS. 28 and 29 showalternative ways of providing reduced pressure to the sealed contractingmember 1228 as will be described further below.

The sealed contracting member 1228 is made of the same or similarmaterials as contracting member 196 (FIG. 1), 616 (FIG. 17A), and 722(FIG. 21A). The sealed contracting member 1228 is sealed to form apneumatic seal about the sealed contracting member 1228. An adhesivelayer 1229 may be used to hold the sealed contracting member 1228 to thebase 1231. An adhesive layer 1235 may be also be used to attach theperipheral edge 1233 of the sealed contracting member 1228 to the wall1251.

At the other end of modular closing member 1208, attachment members 1220may be coupled to each of the second ends 1212 of the modular closingmembers 1208. Referring again primarily to FIG. 25, each of theattachment members 1220 may be formed with a base 1222 and a wall 1224.An adhesive layer may be used to hold the sealed contracting member 1228to the base 1222. An adhesive layer may also be used to hold the sealedcontracting member to the wall 1224. An adhesive may be used to hold theinward-facing side 1236 of the base 1222 against the patient'sepidermis.

Referring now primarily to FIG. 28, an alternative reduced-pressureinterface 1327, which may be used as part of the modular,reduced-pressure closure system 1200, is presented. Reduced pressure maybe provided to a sealed contracting member 1308 through the connectionmember. For example, the modular closing member may have a connectionmember 1316 that selectively attaches to a flexible strap 1302. Anadhesive 1330 may be used to hold the sealed contracting member 1308 tothe connection member 1316. The connection member 1316 may have a wall1324 and a base 1322. A reduced-pressure interface 1327 may be formed onthe base 1322 and configured to enter the sealed contracting member1308. The reduced-pressure interface 1327 is sized and configured toengage a manifold 1380, which is in fluid communication, or is fluidlycoupled, to a reduced-pressure source. The reduced pressure is deliveredto the manifold 1380.

Referring now to FIG. 29, an attachment member 1420, which has a baseportion 1422 and a wall 1424, is shown with an alternativereduced-pressure interface 1426. The reduced-pressure interface 1426 isformed through the wall 1424. A reduced-pressure conduit 1427 deliversreduced pressure from a reduced-pressure source to the reduced-pressureinterface 1426. The reduced-pressure interface 1426 delivers reducedpressure to a sealed contracting member 1428. The sealed contractingmember 1428 may be held to the base 1422 by an attachment device, e.g.,adhesive 1430. The base 1422 may be held by an attachment device 1432,e.g., adhesive 1436, to the patient's epidermis. The sealed contractingmember 1428 may also be held by an attachment device 1432, e.g.,adhesive 1434, to the wall 1424.

With reference again to FIG. 27, in operation, the modular,reduced-pressure closure system 1200 is used by the healthcare providerwho first assesses the size of the surface wound 1206 and determines thenumber of modular closing members 1208 that are appropriate for the sizeof the wound. A lookup table might be provided to suggest the numberbased on the linear measurement of the circumference of the surfacewound 1206. An appropriate number, which make up the desired pluralityof modular closing members 1208, are then selectively coupled to theflexible strap 1202. The flexible strap 1202 is shaped into the closedloop 1204 around the surface wound 1206 and is preferably disposedinboard of the peripheral edges of the surface wound 1206. The closedloop 1204 is secured as a loop using any number of means, such as aratchet, snap, a fastener on the flexible strap 1202, ratchet ties,flexible peg and slot members, etc. Then, each of the plurality ofattachment members 1220 are attached to the patient's epidermisproximate the edge of the surface wound 1206. As before, the statementthat each of the plurality of attachment members 1220 are attached tothe epidermis may include that the attachment member 1220 is attached ontop of a sealing member being used for reduced-pressure treatment. Whenreduced pressure is supplied through the reduced-pressure conduit 1227to the reduced-pressure interface 1226 of each modular closing member1208, a closing force is developed as represented by arrows 1240.

The closed loop 1204 provides an open area in the middle of the loopwhich readily accommodates a reduced-pressure interface 1242 that may beused to supply reduced pressure to a portion of a reduced-pressuretreatment system (see, e.g., subsystem 58 in FIG. 1).

General Operation

Referring primarily to FIG. 1, according to one illustrative approach totreating the open abdominal cavity 32, the healthcare provider may firstput in an open-cavity treatment device 50 as part of an open-cavitytreatment subsystem 52. The open-cavity treatment device 50 may be sizedinitially to fit the particular application. For example, with referenceto FIG. 6, the open-cavity treatment device 202 may be cut along visualindicia 214 through the manipulation zones 212 to properly size thedressing. Referring again to FIG. 1, once the open-cavity treatmentdevice 50 is properly sized, the open-cavity treatment device 50 isplaced within the abdominal cavity 32 and on top of the abdominalcontents 46. The encapsulated leg members 90 of the open-cavitytreatment device 50 may be tucked and worked into desired locations,e.g., the paracolic gutters 92, 94, pelvic cavity, behind a patient'sliver, etc.

The healthcare provider may place the deep-tissue closure device 54 onthe first side (or top for the orientation shown) of the open-cavitytreatment device 50. The deep-tissue closure device 54, which is part ofa deep-tissue closure subsystem 56, may need to be sized by cutting thedeep-tissue closure device 54 to a desired size to accommodate thedeep-tissue wound. The healthcare provider may help to position layersof tissue, namely fascia 36, on the first side (or top for theorientation shown) of the deep-tissue closure device 54. The manifold 64may be inserted within the abdominal cavity 32 and on top of a portionof the deep-tissue closure device 54.

The sealing member 66 may then be placed over the opening of theabdominal cavity 32 and on the epidermis 44 to provide a pneumatic seal.This may be done by removing releasable backing from the adhesive 70 andthen placing the adhesive 70 against the epidermis 44. Then, to helpprovide additional closing force and support, the surface-wound closuresubsystem 60 may be applied. Any of numerous possible embodiments of asurface-wound closure subsystem may be used. In addition, various othersubsystems and alternatives might be used as part of thereduced-pressure, abdominal treatment system 30.

With reference still to FIG. 1, the first attachment member 186 may beapplied on one side of the surface-wound edges 182 and a secondattachment member 193 may be applied generally at a position oppositethe first attachment member 186 and on the other side of surface-woundedge 182. The attachment members 186 and 193 may be attached by removingreleasable backing from an adhesive layer, e.g., first adhesive 192 onthe first attachment member 186, and applying the adhesive against thesealing member 66.

A portion of the reduced-pressure interface 72 may then be placed intoopening 187 of the surface surface-wound closure subsystem 60 and intothe manifold 64. The first reduced-pressure delivery conduit 76 may befluidly coupled to the reduced-pressure interface 72 and to thereduced-pressure supply subsystem 62, which delivers reduced pressure tothe first reduced-pressure delivery conduit 76. The surfacesurface-wound closure subsystem 60 includes at least one secondreduced-pressure interface 194, which is fluidly coupled to a secondreduced-pressure delivery conduit 195. The second reduced-pressuredelivery conduit 195 is fluidly coupled to the reduced-pressure supplysubsystem 62, which delivers a reduced pressure into the secondreduced-pressure delivery conduit 195.

The healthcare provider may then activate the reduced-pressure supplysubsystem 62, which delivers reduced pressure (a first reduced pressureor treatment-reduced-pressure) to the reduced-pressure treatmentsubsystem 58 and in particular to the manifold 64. This reduced pressureis also communicated to the open-cavity treatment device 50 and thedeep-tissue closure device 54. As suggested by the embodiment of FIG.28, reduced pressure might also be supplied to the surface-wound closuresubsystem 60 by the manifold 64, but in the illustrative embodiment ofFIG. 1, reduced pressure (a second reduced pressure orclosing-reduced-pressure) is supplied by the second reduced-pressuredelivery conduit 195 to the sealed contracting member 196 causing thesealed contracting member 196 to contract and pull the surface-woundedges 182 of the epidermis 44 together.

The reduced-pressure, abdominal treatment system 30, and particularlythe open-cavity treatment device 50, helps remove ascites and otherfluids from the abdominal cavity 32 and the tissue site 34 withoutadhering to the abdominal contents 46. The reduced-pressure, abdominaltreatment system 30 utilizes the deep-tissue closure subsystem 56 tohelp close the fascia 36 without the fascia “rolling” or causing otherproblems and without requiring puncture wounds to the fascia 36. Thereduced-pressure, abdominal treatment system 30 helps generally toprovide reduced-pressure treatment within the abdominal cavity 32 by wayof the reduced-pressure treatment subsystem 58, which includes themanifold 64. The reduced-pressure, abdominal treatment system 30 alsohelps close the surface wound 180 in the epidermis 44 by using thesurface surface-wound closure subsystem 60.

Although the present invention and its advantages have been disclosed inthe context of certain illustrative, non-limiting embodiments, it shouldbe understood that various changes, substitutions, permutations, andalterations can be made without departing from the scope of theinvention as defined by the appended claims. It will be appreciated thatany feature that is described in a connection to any one embodiment mayalso be applicable to any other embodiment.

We claim:
 1. A system for providing treatment to an abdominal tissuesite, comprising: an open-cavity treatment device comprising a pluralityof leg members encapsulated by one or more film layers; a manifoldmember adapted to be positioned proximate the open-cavity treatmentdevice and communicate reduced pressure to the plurality of leg membersthrough fenestrations in the first fenestrated film layer, the manifoldmember comprising a substantially arcuate shape, the manifold membercomprising a reticulated polyurethane foam and a felted material appliedto a surface of the reticulated polyurethane foam; and a sealing memberadapted to be positioned over the open-cavity treatment device and themanifold member to provide a pneumatic seal over the abdominal tissuesite.
 2. The system of claim 1, wherein the manifold member comprises areticulated polyurethane foam.
 3. The system of claim 1, wherein themanifold member comprises a plurality of interconnected structuralsections configured to provide a lateral closing force to fascia in theabdominal tissue site.
 4. The system of claim 1, wherein the manifoldmember comprises a polyurethane foam having a plurality ofinterconnected structural sections and a plurality of voids betweenportions of the structural sections, wherein the manifold member isconfigured to provide closing forces to a fascia in the abdominal tissuesite.
 5. The system of claim 1, wherein the manifold member and theopen-cavity treatment device are each configured to provide a closingforce to portions of fascia in the abdominal tissue site underapplication of reduced pressure.
 6. A system for treating an abdominaltissue site, comprising: a non-adherent drape comprising a plurality offenestrations, wherein the non-adherent drape is adapted to be placed incontact with contents of the abdominal tissue site; a plurality ofencapsulated leg members formed on the non-adherent drape, wherein eachof the plurality of encapsulated leg members has an interior portioncomprising a leg manifold member, and wherein the plurality offenestrations are configured to allow fluid flow into the interiorportion of each of the plurality of encapsulated leg members; and amanifold member comprising a polymer foam having a plurality ofinterconnected structural sections, wherein the manifold member isadapted to be positioned at the abdominal tissue site and to communicatereduced pressure to the plurality of encapsulated leg members; whereinthe manifold member and the plurality of encapsulated leg members areconfigured to provide closing forces to fascia in the abdominal tissuesite.
 7. The system of claim 6, further comprising a sealing memberadapted to provide a fluid seal over the abdominal tissue site.
 8. Thesystem of claim 7, further comprising: a reduced-pressure source; and areduced-pressure interface adapted to be fluidly coupled to the sealingmember and operable to deliver reduced pressure from thereduced-pressure source to the manifold member.
 9. The system of claim6, wherein the manifold member comprises a reticulated polyurethanefoam.
 10. The system of claim 6, wherein the manifold member comprises:a reticulated polyurethane foam; and a felted material applied to asurface of the reticulated polyurethane foam.
 11. The system of claim 6,wherein the manifold member has a substantially arcuate shape andcomprises a plurality of voids oriented along one or more edges of themanifold member.
 12. The system of claim 6, wherein the manifold membercomprises a reticulated polyurethane foam having a substantially arcuateshape adapted to be in contact with one or more edges of fascia in theabdominal tissue site.
 13. A system for treating an abdominal cavity ofa patient, comprising: an open-cavity treatment device comprising aplurality of encapsulated leg members, wherein each of the plurality ofencapsulated leg members comprises a leg manifold member disposed withinan interior portion of the encapsulated leg member and is formed withfenestrations operable to allow fluid flow into the interior portion; adeep-tissue closure device configured to be disposed over theopen-cavity treatment device, the deep-tissue closure device comprising:a contractible matrix having a first side and a second, inward-facingside, the first side formed with a plurality of apertures, and thesecond, inward-facing side formed with a plurality of cells, and furtherformed with a plurality of inter-cellular apertures, the second,inward-facing side configured to be deployed proximate the encapsulatedleg members, a manifold member configured to be disposed over thecontractible matrix and operable to distribute reduced pressure, and asealing member operable to provide a pneumatic seal over the abdominalcavity; and a surface-wound closure subsystem configured to be disposedover the manifold member, the surface-wound closure subsystemcomprising: a first attachment member for releasably attaching to afirst portion of an epidermis of the patient, a second attachment memberfor releasably attaching to a second portion of the epidermis of thepatient, and a sealed contracting member operable to contract whenplaced under reduced pressure.
 14. The system of claim 13, furthercomprising a reduced-pressure supply subsystem adapted to be fluidlycoupled to the open-cavity treatment device, the deep-tissue closuredevice, and the surface-wound closure subsystem.
 15. The system of claim13, wherein the open-cavity treatment device further comprises: anon-adherent drape with fenestrations, wherein the plurality ofencapsulated leg members are coupled to the non-adherent drape; and acentral connection member with a connection manifold member, wherein thecentral connection member is coupled to the non-adherent drape and tothe plurality of encapsulated leg members such that each leg manifoldmember is in fluid communication with the connection manifold member.16. The system of claim 15, wherein the non-adherent drape comprises anelastomeric drape having fenestrations and visual indicia that indicatevarious sizes for cutting.
 17. The system of claim 13, wherein thesurface-wound closure subsystem comprises: a sealed contracting member;a plurality of attachment-base members, each attachment-base memberhaving a base and a first wall having a first end and a second end, thefirst end of the first wall having a first movable connection member andthe second end of the first wall having a second movable connectionmember, each attachment-base member for releasably attaching to aportion of the epidermis and for coupling to the sealed contractingmember; a plurality of connecting members, each connecting member havinga second wall with a first end and a second end, the first end of thesecond wall having a third movable connection member and the second endof the second wall having a fourth movable connection member, eachconnecting member for moveably coupling to one of the plurality ofattachment-base members; a reduced-pressure interface adapted to befluidly coupled to the sealed contracting member, the reduced-pressureinterface operable to deliver reduced pressure to the sealed contractingmember; and wherein the plurality of attachment-base members and theplurality of connecting members are operable to moveably couple to forma circumferential wall defining an interior space and wherein the sealedcontracting member is to be disposed within the interior space.
 18. Thesystem of claim 13, wherein the surface-wound closure subsystemcomprises: a flexible strap operable to be formed into a closed loop;and a plurality of modular closing members, wherein each of theplurality of modular closing members comprises: an attachment member forreleasably attaching to a portion of the epidermis of the patientproximate an edge of a surface wound, the attachment member formed witha base and a wall, a sealed contracting member having a first end and asecond end, wherein the sealed contracting member is operable tocontract when placed under reduced pressure, wherein the second end ofthe sealed contracting member is coupled to the attachment member, aconnection member, the connection member operable to selectively coupleto the flexible strap, wherein the connection member is coupled to thefirst end of the sealed contracting member; and a reduced-pressureinterface adapted to be fluidly coupled to the sealed contracting memberfor delivering reduced pressure to the sealed contracting member.